Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Case Report

Volume 9, Number 1, February 2018, pages 46-49

Critical Management of Severe Hypotension Caused by Amlodipine Toxicity Managed With Hyperinsulinemia/Euglycemia Therapy Supplemented With Calcium Gluconate, Intravenous Glucagon and Other Vasopressor Support: Review of Literature

**Table 1.** Various Treatment Methods Used in CCB Overdose
1) Decontamination
a) Activated charcoal: single dose of 50 g for adults
b) Polyethylene glycol whole bowel irrigation: 2 L/h in adults until rectal effluent is clear
2) Supportive therapy
a) Intravenous fluids
b) Atropine: 1 mg IV (can be repeated up to 3 mg total)
3) Antidotes
a) Calcium salts: i) calcium chloride: 10 - 20 mL of a 10% solution administered over 10 min (can repeat dose if no effect); ii) calcium gluconate: 30 - 60 mL of a 10% solution (dose can be repeated if no effect); iii) continuous infusion with either salt: 0.5 mEq of Ca/kg/h
b) Glucagon: 5 mg IV bolus, can be repeated twice at 10 min intervals
4) Phosphodiesterase inhibitor (e.g., amrinone and milrinone)
5) Adrenergic agents (e.g., norepinephrine and dopamine, etc.)
6) HIE
a) Regular insulin bolus of 0.1 U/kg IV and then continuous infusion of 0.2 - 0.5 U/kg/h
b) Dextrose 25 - 50 g bolus followed by a continuous infusion of 0.5 g glucose/kg/h that can be titrated to appropriate blood glucose.
7) Invasive therapy
a) Transvenous pacing
b) Intraaortic balloon pump
c) Cardiopulmonary bypass
d) Extracorporeal membrane oxygenation

Table 1. Various Treatment Methods Used in CCB Overdose

1) Decontamination

a) Activated charcoal: single dose of 50 g for adults

b) Polyethylene glycol whole bowel irrigation: 2 L/h in adults until rectal effluent is clear

2) Supportive therapy

a) Intravenous fluids

b) Atropine: 1 mg IV (can be repeated up to 3 mg total)

3) Antidotes

a) Calcium salts: i) calcium chloride: 10 - 20 mL of a 10% solution administered over 10 min (can repeat dose if no effect); ii) calcium gluconate: 30 - 60 mL of a 10% solution (dose can be repeated if no effect); iii) continuous infusion with either salt: 0.5 mEq of Ca/kg/h

b) Glucagon: 5 mg IV bolus, can be repeated twice at 10 min intervals

4) Phosphodiesterase inhibitor (e.g., amrinone and milrinone)

5) Adrenergic agents (e.g., norepinephrine and dopamine, etc.)

6) HIE

a) Regular insulin bolus of 0.1 U/kg IV and then continuous infusion of 0.2 - 0.5 U/kg/h

b) Dextrose 25 - 50 g bolus followed by a continuous infusion of 0.5 g glucose/kg/h that can be titrated to appropriate blood glucose.

7) Invasive therapy

a) Transvenous pacing

b) Intraaortic balloon pump

c) Cardiopulmonary bypass

d) Extracorporeal membrane oxygenation